Prenatal diagnosis of fetal defects and its implications on the delivery mode

Abstract

Congenital malformations are defined as single or multiple defects of the morphogenesis of organs or body parts, identifiable during intrauterine life or at birth. With recent advances in prenatal detection of congenital malformations, many of these disorders can be identified early on a routine fetal ultrasound. The aim of the present systematic review is to systematize the current knowledge about the mode of delivery in pregnancies complicated by fetal anomalies. The databases Medline and Ebsco were searched from 2002 to 2022. The inclusion criteria were prenatally diagnosed fetal malformation, singleton pregnancy, and known delivery mode. After the first round of research, 546 studies were found. For further analysis, studies with full text available concerning human single pregnancy with known neonatal outcomes were considered. Publications were divided into six groups: congenital heart defects, neural tube defects, gastroschisis, fetal tumors, microcephaly, and lung and thorax malformations. Eighteen articles with a descripted delivery mode and neonatal outcome were chosen for further analysis. In most pregnancies complicated by the presence of fetal anomalies, spontaneous vaginal delivery should be a primary option, as it is associated with lower maternal morbidity and mortality. Cesarean delivery is generally indicated if a fetal anomaly is associated with the risk of dystocia, bleeding, or disruption of a protective sac; examples of such anomalies include giant omphaloceles, severe hydrocephalus, and large myelomeningocele and teratomas. Fetal anatomy ultrasound should be carried out early, leaving enough time to familiarize parents with all available options, including pregnancy termination, if an anomaly is detected.

Fetal Heart Diseases and Neonatal Mortality: Risk Factors and Management

“…According to Lucron H and Derridj N, the severity of cardiac disease is a key determinant of mortality, with having group-2 heart disease increasing neonatal mortality by 2.9 times and group-3 heart disease by 5.3 times in our study [5,6]. Surgical success and thus neonatal outcomes can vary based on the technical capabilities of the center where the cardiac surgery is performed [10], the experience of the surgical team, the presence of a cardiac surgical unit at the place of birth, and the conditions of the neonatal intensive care unit [25].…”

The Association of Prenatal Diagnoses with Mortality and Long-Term Morbidity in Children with Specific Isolated Congenital Anomalies: A European Register-Based Cohort Study

“…Detection of congenital anomalies before birth allows better planning of prenatal and postnatal care (Gamba and Midrio 2014 ; Grivell et al, 2014 ). In recent years, it has also allowed prenatal fetal therapy to be performed in rare cases (Sadlecki and Walentowicz-Sadlecka, 2023 ). Often, however, prenatal diagnosis seems not to result in better outcomes, but instead predicts poorer outcomes, possibly due to the more severe cases being more likely to be detected prenatally (Peyvandi et al, 2016 ; Lazar et al, 2011 ).…”